Headlines: November 25, 2010

Meg Larkin

In public health news today, a new study has been released that finds no progress in improving patient safety at hospitals.The study was led by Dr. Christopher P. Landrigan, an assistant professor at Harvard Medical School, and it looked at ten hospitals in North Carolina for the five year period between 2002 and 2007.The new study is the most rigorous examination of hospital errors since the 1999 Institute of Medicine report To Err is Human. The New York times reported that, “instead of improvements, the researchers found a high rate of problems. About 18 percent of patients were harmed by medical care, some more than once, and 63.1 percent of the injuries were judged to be preventable. Most of the problems were temporary and treatable, but some were serious, and a few — 2.4 percent — caused or contributed to a patient’s death.” The report comes on the heels of a similar report finding that 13.5 percent of Medicare beneficiaries suffered adverse incidents during the course of a hospitalization. Both reports highlight the problem of iatrogenic illness in American medical care and have led to calls from the government and trade groups for improvements in the hospital systems.

In regulatory news, the government has ordered a vast review of protections for participants in government-funded human subjects research. In a memo released yesterday, President Obama calls for, “a review of federal and international standards to guard the health and well-being of research participants.” The review comes as a response to revelations earlier this year that researchers from the United States deliberately infected residents at a Guatemalan mental hospital with syphilis in the 1940s in order to study the effects of penicillin on the disease. The call for a review of human subjects protections comes at the same time that the White House has called for an investigation into what happened in the Guatemalan study.

In other government news, there are two stories out today about the implementation of the new health care law. First, the incentives created by the health care law have led to a high rate of mergers among health care organizations. The law creates favorable treatment for “accountable care organizations,” which are intended to provide more integrated health care services and improve patient outcomes. However, some consumer advocates are worried that an increase in concentration in the health care industry will lead to monopolization and other antitrust concerns that could work to the detriment of patients. The regulations that will govern the treatment of ACOs under the new law are currently being written, and regulators are facing strong lobbying from all sides of the debate. Hospitals and doctors’ groups are pushing regulators to create antitrust exemptions for the new organizations, while the FTC has accused the doctors of price-fixing. It remains to be seen what the final shape of the legislation will be.

Second, the Obama Administration has issued new rules governing medical spending by insurers under the health reform law. According to the Washington Post, “insurers must spend at least $4 out of $5 they collect through premiums on direct medical services and other means to improve Americans' health.” The rules will take effect in January along with a host of new reporting requirements that will allow regulators to see how insurers are spending the money that they collect through premiums. The regulations do, however, allow smaller health plans more time to come into compliance. States are also allowed to ask for exemptions if they feel that the regulations will have a severe adverse effect on the availability of insurance in their state.

Finally, in research news, a daily antiretroviral pill has been found to dramatically reduce the risk of contracting AIDS. The New York Times reported that, “In the study, published Tuesday by the New England Journal of Medicine, researchers found that the men taking Truvada, a common combination of two antiretroviral drugs, were 44 percent less likely to get infected with the virus that causes AIDS than an equal number taking a placebo.” The rate of prevention went up to 90% among those who faithfully took the drug every day as directed. The drug is currently on the market, and while it is not approved by the FDA for AIDS prevention, doctors may now be more willing to prescribe it for that purpose. More studies are now underway hoping to confirm the results of this study, and to examine the drug’s efficacy among heterosexuals. AIDS awareness advocates caution that other safe sex practices should still be encouraged as a primary means of prevention.

A happy Thanksgiving from Meg and everyone else at ASLME. As always, please feel free to email with any comments, questions, suggestions or concerns.